Twenty years ago, few people diagnosed with acute myeloid leukemia (AML) could expect a cure or have the disease go into remission. When cancer is in remission, it means tests show little or no evidence of disease, and you have no symptoms.  

Today, the outlook for people with AML is brighter, although the disease remains difficult to cure. Ongoing research is leading to life-changing advancements in treatments, including new targeted therapies.

What can people with acute myeloid leukemia expect from treatments?

The goal of AML treatment is to put the disease in remission. People with AML usually receive chemotherapy first to kill cancer cells circulating in the blood. This phase is known as remission induction therapy. 

The second phase of treatment — post-remission therapy — focuses on preventing cancer relapse or recurrence by keeping inactive cancer cells from activating again.

What are expected AML treatment outcomes?

Everyone responds to treatment differently, and there are different treatment outcomes. Doctors measure outcomes in four ways:

1. Active disease: Cancer remains active during treatment, after treatment (refractory), or returns after treatment ends (cancer relapse or recurrence).

2. Remission: There’s no evidence of disease (NED) after treatment. You have no symptoms, blood cell counts are within the normal range, and there are fewer than 5% leukemic blasts (cancerous cells) in bone marrow.

3. Minimal residual disease: Standard blood or bone marrow tests show no evidence of disease. However, more sensitive tests such as flow cytometry and polymerase chain reaction (PCR) detect AML cells in bone marrow.

4. Complete molecular remission: The most accurate test, PCR, finds no AML cells.

What’s the outlook for adults with acute myeloid leukemia?

Approximately 11,000 people (most of them adults) die from AML every year. While that number is alarming, AML accounts for fewer than 2% of all cancer-related deaths. 

It’s estimated that 2 out of 3 adults with AML go into remission after the first phase of treatment. Up to half of people in remission later go into long-term remission - and may actually be cured - after the second phase of treatment. In fact, the five-year relative survival rate for people with all types of leukemia has more than quadrupled since the 1960s. 

When doctors refer to a five-year relative survival rate, they mean the percentage of people who are alive at least five years after the initial cancer diagnosis compared to people who don’t have the disease. Close to 1 in 3 adults over the age of 20 are alive five years after an AML diagnosis. Some people with AML live 10 years or more.

What’s the outlook for children with acute myeloid leukemia?

Children tend to respond more favorably to AML treatments than adults. Up to 90% of children with AML go into remission after induction therapy, the first phase of treatment. These children still need other treatments (post-remission therapy) to destroy lingering cancer cells.

Fewer than 15% of children have refractory AML, or cancer that doesn’t respond to treatment. The prognosis for these children isn’t as good as for children who experience a recurrence of AML after remission. Two out of three children and young adults under the age of 20 are alive five years after an AML diagnosis.

What factors affect acute myeloid leukemia survival rates?

The key factors that play a role in determining life expectancy for someone with AML include:

• age and general health

• AML subtype

• cancer history

• cancer response to treatment

• cancer spread (metastasis) 

• white blood cell count

Age and general health

Studies show that more than half of people with AML receive the diagnosis after age 65, but only about 40% of people start chemotherapy treatment within three months of diagnosis. Older people with AML typically don’t fare as well as younger people. 

Older people often have other medical conditions (comorbidities) such as diabetes, high blood pressure, excess weight, or heart disease that make it harder to tolerate strong chemotherapy drugs or other AML treatments. Older people are also more likely to have chromosome abnormalities that don’t respond well to treatments. 

Survival rates for children with AML are higher than rates for older adults because children are often healthier at the time of diagnosis.

AML subtype

There are a couple different ways to classify AML subtypes. This classification occurs at the time of AML diagnosis. Knowing the subtype is important because some subtypes respond better to treatment. 

Subtypes are based on:

• chromosomal abnormalities, such as extra, missing, or transposed (changed) chromosomes

• gene mutations (mutated NPM1 or CEBPalpha genes respond well to chemotherapy while a mutated FLT3 gene does not)

• morphology (how cancer cells look under a microscope)

Cancer history

People who develop AML after undergoing treatment for a different type of cancer have less positive outcomes. Having another type of blood cancer, such as myelodysplastic syndrome or myeloproliferative neoplasm, also leads to a poorer prognosis.

Cancer response to treatment

People with refractory AML (cancer that doesn’t respond to treatment) or recurring AML (cancer that returns after treatment and remission) may not respond well to continued treatment.

Cancer spread (metastasis)

AML that spreads (metastasizes) to the brain, spine, or other parts of the central nervous system is more difficult to treat.

White blood cell count

White blood cells help the body fight infection. People who have a high white blood cell count (above 100,000 cells per microliter) at the time of diagnosis are more likely to experience disease complications and poorer outcomes.

What steps can improve survival odds?

If your AML remains active, you’ll continue to receive chemotherapy or other treatment. If you’re in remission, you still need long-term follow-up exams to ensure the disease stays in remission and for your doctor to check for signs of recurrence. 

Monitoring disease recurrence is key to helping you live longer. AML that returns typically does so shortly after treatment ends. You may need monthly blood or bone marrow tests for the first year or so after finishing treatment. It’s unusual for AML to return after you’ve been in remission for several years.

What steps can enhance quality of life?

Living with a chronic, life-threatening disease like AML is challenging. These steps can help improve your quality of life:

• Connect with members of the Inspire Leukemia Support Community.

• Get palliative care for disease symptoms.

• Participate in support groups online or in person.

• See a mental health counselor.

• Talk to a dietitian about ways to manage treatment side effects such as loss of appetite and nausea.

From the community: “I was diagnosed with AML.... Underwent induction chemo immediately upon diagnosis and was in hospital for about 6 weeks. Rough but got through it. Consolidation chemo is heavy duty stuff for one week, to induce the remission. Then I had 3 rounds of consolidation chemo over about 3-4 months, then a 1 month break followed by a bone marrow transplant (my specific type of AML has higher risk for relapse so transplant was recommended). All this transpired in [one year]… Everyone's story is different (age, health at diagnosis, genetic mutations of the disease, etc.) so it can be hard to get faith from experiences of others, but please try to have faith in your team. I wish you well and will send prayers to you.” - Inspire member

Sources

• Acute Myeloid Leukemia (AML) Subtypes and Prognosis. American Cancer Society. August 2018.

• Key Statistics for Acute Myeloid Leukemia. American Cancer Society. January 2020.

• Living as an Acute Myeloid Leukemia (AML) Survivor. American Cancer Society. August 2018.

• Treatment of Children with Acute Myeloid Leukemia. American Cancer Society. June 2020.

• Treatment Response Rates for Acute Myeloid Leukemia. American Cancer Society. August 2018.

• Leukemia – Acute Myeloid – AML: Statistics. American Society of Clinical Oncology. January 2020.

• Leukemia – Acute Myeloid – AML: Subtypes. American Society of Clinical Oncology. June 2017.

• Medeiros, et al. Big Data Analysis of Treatment Patterns and Outcomes Among Elderly Acute Myeloid Leukemia Patients in the United States. Annals of Hematology. March 2015.

• Acute Myeloid Leukemia. Leukemia and Lymphoma Society. August 2019.

• Childhood AML. Leukemia and Lymphoma Society. 

• Facts and Statistics. Leukemia and Lymphoma Society.

• Treatment Outcomes. Leukemia and Lymphoma Society.

• Cancer Stat Facts: Leukemia – Acute Myeloid Leukemia (AML). National Cancer Institute.

Disclaimer

Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.